Plantar Fasciitis

• Pain under the heel which develops gradually over time.
• Often pain may radiate forwards into the arch of the foot.
• There may be tenderness in the sole of the foot and under the heel when pressing in. This can range from being slightly uncomfortable to acutely painful.
• Pain is usually worse first thing in the morning and improves during the day.

Other injuries which are sometimes confused with Plantar fasciitis are:

• Bruised heel – bruising of the tissues under the heel. Pain does not normally radiate into the arch and is not worse first thing in the morning.
• Heel spur – is a tiny bone growth at the point where the plantar fascia attaches to the heel and can occur at the same times as Plantar fasciitis.
• Calcaneal stress fracture – is a stress fracture of the heel bone. Pain does not normally radiate into the arch.

Below we outline some common differences between plantar fasciitis and bruised heel.

The Plantar Fascia (or plantar aponeurosis) is a broad, thick band of tissue which runs from under the heel bone (calcaneus), to the front of the foot. Its function is to provide support to the foot when standing and shock absorption when running. Inflammation or degeneration of the tendon where the fascia originates at the heel causes pain.

Plantar fasciitis or Plantar fasciopathy?

The term Plantar fasciitis refers to inflammation (‘itis’ means inflammation). Traditionally people thought inflammation was the issue. However, studies have shown actual inflammatory cells are not present in most cases. Therefore, degeneration of the tissues is thought to be a more likely cause. Hence the term Plantar fasciopathy is more appropriate.

Overuse is thought to be the main cause of plantar fasciitis. It is more common in sports which involve running, dancing or jumping. However, there are a number of factors which can increase your chances of developing Plantar fasciitis heel pain:

Foot Biomechanics

Overpronation is where the foot rolls in or flattens too much when running or walking. As the foot flattens, it stretches the plantar fascia more than normal, therefore increasing the strain on the tissues.

A foot which has a high arch is known as pes cavus. This foot type is often rigid and therefore unable to absorb shock and impact forces. Therefore, the strain on the plantar fascia is increased.

• More on Overpronation

Footwear

Wearing inappropriate footwear such as very flat and unsupporting shoes can increase the likelihood of developing plantar fasciitis. If you are a runner then choosing the correct running shoes for your foot type is essential. If you overpronated then a motion control shoe is best. Oversupinators often have a high arch and a neutral shoe with cushioning is usually advised.

• More on Choosing running shoes

Bodyweight

Overweight individuals or those who do a lot of heaving lifting at the workplace increased loads on the foot. Therefore, increasing the chances of developing heel pain.

Flexibility

If you have tight calf muscles or plantar fascia then you are at a higher risk of developing plantar fasciitis. Or, if you have tight hamstrings or gluteal muscles then this also increases your risk because of the effect they have on foot biomechanics.

• Plantar fasiitis stretches

Download our FREE Plantar Fasciitis rehabilitation app: Iphone | Android

Treatment consists of reducing pain and inflammation, stretching the plantar fascia and lower leg muscles and identifying potential causes. View our full rehab program for treating plantar fasciitis.

Cold therapy

Apply the PRICE principles of protection, rest, ice, compression and elevation to relieve pain and inflammation. Do not apply ice directly to the skin as it may cause ice burns. Wrap ice in a wet tea towel or use a commercially available gel pack.

Apply ice or cold therapy for up to 10 minutes every hour whilst it is particularly painful. Reduce this to 3 times a day as symptoms improve and additionally after exercise.

Plantar fasciitis taping

Taping is an excellent way of instantly relieving symptoms. It works by supporting the arch of the foot and reducing the strain on the plantar fascia.

This, therefore, allows the tissues to heal. You may need to apply tape regularly until symptoms resolve but many people notice an immediate improvement.

• How to tape for Plantar fasciitis

Footwear & Insoles

Protect and support the foot by wearing comfortable shoes or trainers. Hard or flat-soled shoes are likely to make symptoms worse. You can wear a cushioning heel pad or insole to help relieve pain. However, if overpronation is an issue then orthotic type insoles will be more appropriate long term.

Plantar fasciitis night splint

A night splint is a very effective way of treating Plantar fasciitis. It is worn overnight and helps prevent the Plantar fascia and calf muscles from gradually tightening up.

As a result, your heel is much less painful and tender first thing in the morning.

Massage for Plantar fasciitis

In the later stages, a professional therapist may apply deep tissue massage to help stretch and relax the plantar fascia. Massage helps to stimulate blood flow and loosen tight tissues underneath the foot which cause pain.

Electrotherapy

Extracorporeal Shock Wave Therapy – is a method of therapeutic treatment for soft tissue injuries. It works by passing shock waves (short but intense energy waves) which travel faster than the speed of sound, into the tissues.

Ultrasound – transmits high frequency sound waves into the tissues. This has a micro massage effect and can reduce pain and inflammation.

Medication

A doctor may prescribe anti-inflammatory medication such as ibuprofen. This may be effective in the early stages to reduce pain and inflammation. But long term use may actually inhibit healing.

Gait analysis

This involves analysing your feet and how they function when you walk and run. If you overpronate, or your feet flatten then this increases the stress on the plantar fascia. Orthotic inserts may be prescribed to help correct any biomechanical issues of the foot.

• More on Overpronation

For more stubborn injuries a doctor may use a corticosteroid injection. Platelet-rich plasma injections have also been shown to be effective. If symptoms do not resolve then surgery is an option but this is rare.

Stretching

Exercises to stretch the plantar fascia and the calf muscles are an important part of treatment and recovery. Rest alone may reduce pain and inflammation but if part of the cause is tension in fascia then your pain is likely to recur.

Plantar Fascia Stretch is done by pulling the foot and toes upwards aiming to feel a stretch in the arch of the foot. Calf muscle stretches should be done both with the leg straight and with the bent, 3 to 5 times a day.

Foot rolling

This involves rolling your foot over a ball, massage roller or even a can of beans! it can also help stretch the plantar fascia underneath your foot.

Strengthening

As this is an overuse injury, the priority is on rest and stretching. However, in some cases exercises to strengthen the arch can help prevent the injury recurring.

Exercises for other parts of the body can be done. See our full Plantar fasciitis rehabilitation program for more details.

• View all Plantar Fasciitis exercises
• View Plantar fasciitis rehabilitation program

Surgery is used in around 5% of people whose symptoms do not improve after a minimum of nine months, even after continuous treatment. However, the success rate is still only estimated at around 70-80%. In most cases now, a procedure called a plantar fascia release is performed.

This releases (cuts) between 30 and 50% of the fascia’s fibers. This helps to reduce the stress on the fascia. Complications can include nerve damage, fallen arches, infection and ongoing symptoms. Recovery after surgery if successful is around 9 to12 weeks before the patient may return to work.

We recommend the following products to help treat Plantar fasciitis heel pain:

Plantar Fasciitis Night Splint

The Plantar fasciitis night splint is worn over night and helps prevent the plantar fascia and calf muscles tightening up. As a result, morning stiffness is significantly reduced.

Cold Therapy Compression Wrap

Cold therapy is important for reducing pain and inflammation. A reusable gel pack can be used for both hot and cold and an elastic sleeve enables easy application and compression.

Foot Massage Roller

The Plantar fasciitis night splint is worn over night and helps prevent the plantar fascia and calf muscles tightening up. As a result, morning stiffness is significantly reduced.

Zinc oxide tape

A roll of 2.5cm zinc oxide sports tape is all that is needed to apply a simple but highly effected Plantar fasciitis foot taping.

Orthotic insoles

Othotic insoles help control the position of your foot and prevent overpronation (rolling in/flattening).

• Lemont H, Ammirati KM, Ulsen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234-37
  
• Riddle DL, Pulisic M, Pidcoe P et al. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Br 2003;85-A(5):872-7
  
• Gonnade N1, Bajpayee A2 et al Regenerative efficacy of therapeutic quality platelet-rich plasma injections versus phonophoresis with kinesiotaping for the treatment of chronic plantar fasciitis: A prospective randomized pilot study. Asian J Transfus Sci. 2018 Jul-Dec;12(2):105-111
  
• Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantar fascia release: A current concept review. Foot Ankle Surg. 2018 Dec 23. pii: S1268-7731(18)30233-9